“Mental health—or social and emotional well-being—is fundamental to human development and essential for all children to flourish. Yet at any given time, an estimated 14% of children (or 800,000 in Canada) experience mental disorders causing significant symptoms and impairment, exacerbating matters, clinical treatment services still reach fewer than 25% of these children despite substantial public investments in health care. Meanwhile, there are almost no investments in programs that could address determinants and prevent problems. Consequently, mental disorders unnecessarily persist throughout the lifespan, with adverse outcomes ranging from reduced educational and occupational chances to increased mortality. The associated economic burden is now estimated to exceed $51 billion in Canada annually, urgently underscoring the need to better address mental health starting in childhood. To address children’s mental health adequately, a new comprehensive population health approach is needed—promoting healthy development for all children and preventing disorders in children at risk, in addition to providing effective treatment for children with established problems and disorders.”

“Canada urgently requires a population health approach to children’s mental health—promoting health and preventing disorders, in addition to providing treatment. Underpinning this approach, indicators could enable population monitoring, thereby informing ongoing public investments.”

“Strategically, monitoring could also raise public awareness about the importance of children’s mental health—understanding that ‘what gets counted, counts.'”

“A population health approach for children’s mental health—promoting health and preventing disorders, in addition to providing treatment—requires a correspondingly broad framework encompassing concepts central to the social and emotional well-being of the entire population of children. Therefore we propose a comprehensive framework that covers: major developmental stages; determinants and contexts; mental health status and related developmental domains; and a wide range of intervention approaches.”

Gratitude to Charlotte Waddell, Cody A. Shepherd, and Alice Chen from Simon Fraser and Michael H. Boyle from McMaster for all the work that went into this project and for reporting the results so we could learn from them.

Brain development

Outdated notion: Brains develop largely during the first few years of life, without much change in later years.

What we now know: Brains evolve over time. Some very specific abilities must develop within what we currently believe are strict windows of opportunity, but most are turning out to be more flexible than previously thought. In fact, brains are constantly developing and changing, even into old age, and “time windows” are different among different individuals.

Brains and trauma

Outdated notion: Brain development and functioning can only be disrupted by physical trauma.

What we now know: Physical trauma is disruptive, but emotional trauma and stress can also disrupt brain development. Some brain pathways are more vulnerable to the effects of stress than others, and this changes with age.

Brains and recovery/repair

Outdated notion: Once disruption occurs, the brain has a very limited capacity to recover, and that capacity is mainly restricted to early childhood.

What we now know: While things like age, sex, and prior experience can influence how well the brain recovers from trauma, all individuals at all ages can adapt or improve given appropriate immediate and long-term interventions.

Brains and genetics

Outdated notion: The role your DNA plays in brain development and functioning is set in stone.

What we now know: The way DNA influences brain development and functioning is influenced by life experiences and can change over time – in every single cell in your brain

At the meeting of the Shared Measurement constellation on Tuesday January 13th at CRD Headquarters, we started the process of shortlisting indicators for use in the Shared Measurement system for the Child & Youth Health Network.

We recognize that selection of indicators will be an iterative process. It will be informed by the work of the Framework/Common Agenda constellation and will be refined by the collective.

It will take some time to get it right.

This is just a first step, but the more perspectives we can bring to this process, the better.

Choose 15 of the 51 indicators on this list. Focus your selections on the shared measurement system of the Child & Youth Health Network, rather than your particular area of interest. (Keep in mind: what get’s measured, get’s done. We want our measurement system to reinforce the activities what will get us to our our collective goal).

E-mail your top 15 indicators #s to petra@ypsn.ca. In the e-mail, describe the criteria you used for selecting those 15 indicators.

Share this exercise with anyone/everyone with a stake in the health & well-bring of children, youth & families in the capital region.

To engage in shared measurement, we need to adopt shared indicators that can be measured by each service-delivery partner in the initiative, so we can track our collective progress toward our goals.

We know much of this work has already been done, and can be adapted to our purposes.

For example, here’s a list of indicators for monitoring the social determinants of health (SDH) found on the Action:SDH website (find the full list here). The following relate directly to young people in a Canadian context:

Proportion of young people not in school or employment, by age and sex;

Literacy rate;

Completion of primary/secondary education by ethnic/ “race” group in a country;

Newborns with low birth weight (% by mother’s education);

Children aged <5 years with moderately or extremely low values for weight and height;

Prevalence of obesity (by wealth quintiles).

Applying the Social Determinants of Health

Sam Bradd graphically documented strategic-level dialogue around the Social Determinants of Health by the the First Nations Health Authority, First Nations Health Directors Association, and First Nations Health Council in BC in October 2013. Find the graphics he created based on that dialogue here.

Upstream is a Saskatchewan-based organization devoted to using the Social Determinants of Health to leverage social change. According to Upstream: “Upstream interventions start at home. When everyone has access to adequate housing, nutritious food, and support for early childhood development, we are thinking and acting upstream.”

Measuring the Social Determinants of Health

As for using the Social Determinants of Health for measurement, the Action: SDH site notes that “Effective action on social determinants requires monitoring and measurement to inform policy-making, evaluate implementation, and build accountability. Inequities in health outcomes, social determinants, and the impact of policies must be monitored. Key requirements are collecting and monitoring indicators of social determinants from different sectors, linking with health outcomes, and monitoring inequities; establishing whole-of-society targets towards the reduction of health inequities; and disaggregating data to better understand baseline levels and potential impacts of policies.

Indicators selected for monitoring policies aimed at reducing health inequities need to be clearly understood by policy-makers across the different sectors that influence the social determinants as well as by communities. Thus simpler measures may be more transparent and easier to interpret than complex summary measures.”